Đặc điểm mô bệnh học và sự bộc lộ một số dấu ấn miễn dịch trong u mô đệm dạ dày - ruột (GIST)

nhan Idn tudi vS benh eanh ISm sang nang: 16'n ban

45 tudi chiem ty le 93%, chu yeu IS >60 tudi; Nam

nhieu han nu"; Cd 71,43% IS hpi ehirng ddng mach

vSnh cap, 28,57% IS can dau thit ngue 6n djnh hay

cSc dang benh dpng mach vSnh man tfnh khSc, trong

dd nhdi mSu ca tim cip chiem 56%. Da sd benh nhSn

cd nhieu yeu td nguy ea benh tim mach, trong d6 cd

74% b§nh nhSn co tir 2 yeu td nguy ca trd len:

58,33% benh nhan nam c6n dang hiit .thudc IS tai thd'i

diem bj benh; 72,48% cd tang huyet Sp; 77,92 % eo

rdi loan lipid mSu. Han 2/3 benh nhan cd ft nhit 2

nhSnh dpng mach vSnh bj tdn thuang.

2. Toa thudc xuit vien: Da sd toa thudc liie xuat

vien BVCR vS DHYD phu hap khuyen cSo hien tai.

Trong toa cd Aspirin 99,02%; elopidogrel 100%; u'C

che men chuyen: 96,10 %; ue ehe beta 91,56%;

statin 93,83%; thudc ha lipid mSu 98,70%.'

Kien nghi: Da sd benh nhan dat stent dpng mach

vSnh IS benh nhSn Idn tudi, eo bleu hien ISm sSng

nang, chup mach vSnh cho thiy cd nhi^u nhSnh ddna

mach vSnh bj tdn thuang, tr§n ca dja cd nhidu y^u to

nguy ca. Do dd kha nSng tSi phSt b$nh t$t vS nguy

ca tii' vong vin edn rit cao, dii d§ dup-c can thi$p

mach vSnh. Vin de didu trj ndi khoa ti6p theo IS circ

ky quan trpng. Do dd cin cd phSc do dieu trj tdi uu vS

c6 chuang trinh quan I^J' nhic nhd b$nh nhSn tuSn

thu dieu tri ISu dSi.

TAI UEU THAM KHA O • -

1) '.xhuyen cSo cua Hpi Tim mach hpe Viet Nt i ve

can thi^p dpng mach vanh qua da" (2008). Khuyen cao ve

cic b$nh ly tim m^ch va chuyin hda. Nha xuat ban Y hpe,

tr: 531-535.

2) "ACC/AHA Guidline for the management of patientk

with ST segment elevation myocardial infarction" (2004). A

repcrt of the American college of cardiology /American

Heart Association. Task force on Practice Guidelines.

3) "ACC/AHA Guidline Update for the management of

patients with unstable Stngiria and non- ST segment

elevation myocardial infarction" (2007). A report of the

American college of cardiology /American Heart

Association. Task force on Practice Guidelines.

4) "ACC/AHA/SCAIS 2007 Guidline Update for

percutaneous coronary inten/ention". A report of the

American college of cardiology /American Heart

Association. Tasl< force on Practice Guidelines.

5) Mori J. Krantz; William A. Baker (2007).

"Comprehensive coronary artery disease care in a Safety -

net hospital: results of get with the guidelines quality

improvement initiative". JMCPvo\ 13 (4).

6) "NCEP Report, implications of recent clinical trials

for the National cholesterol education program Adult

treatment Panel III guidelines. Circulation 2004; 110:227-

239.

7) "Third report of the national cholesterol education

program (NCEP)' (2002). National cholesterol education

program. National heart, lung and blood pressure. NIM

publication. No 02-5215.

DAC DIEM MO BENH HOC VA SIT BOC LO MOT SO DAU AN MIEN DjCH

TRONG U MO DEM DA DAY-RUOT (GIST)

NGUYI N VA N MA O - Dai hoc Y Duac Hue

NGUYI N PHUC Cl/ONG, PHAM KIM BINH - BV Viet Ddc, Hi Noi

TRAN VA N HO P - Dai hgc Y Hi Npi

TA VAN TO, NGUYI N PHI HUNG - BSnh vien K Hi Ndi

DAT VAN DE

U mo dem da day-rupt hay u mo dem dng tieu hda

la mpt trong nhifng loai u trung mo (u nam dudi niem

mac, khdng phai u bleu mo) te bao hinh thoi hoac/va

dang bieu m6 cd bpc 16 da'u an CD117 (c-kit) ve mat

hoa m6 miln djeh [2], [3], [6], [9]. Loai u nay khi phan

ti'ch gen thudng cd dot bien gen c-kit (75 - 80%) hoac

gen PDGFRA (5%) [2], [5], [6], [9]. TrUdc day chiing

thudng dUde chan doan la u cd trdn hoac u than kinh

lanh hoac ac tfnh. NhUng tir nhifng nam 40 cua the ky

20, mpt sd tae gia da phat hien mpt nhdm u vdi cac

dae diem khac biet vS dUde gpi ten IS u cd trdn ky dj,

u Stout cho eae u trung m6 c6 te bao dang bieu m6.

Den thap nien 80 Mazur, Clark gpi nhom u nSy la u

m6 dem dng tieu hda [8]. Tuy nhien ngudn gde eiia

chiing vin chua dUdc biet ro. Nhd sif phSt trien cOa

khoa hoc ky thuat, dae biet IS hda mo.miin dich,

ngUdi ta phat hien tha'y nhdm u nSy hau nhu khdng

boc 16 da'u an biet hoa hoan toan cua cd trdn nhU cd

the dUdng tfnh vdi SMA nhUng am tfnh vdi Desmin,

hay cua than kinh nhU cd the dUdng tinh vdi NSE

nhuTig hiem khi dUdng tfnh vdi SI00. Oac biet, nhdm

u nSy bpc Id da'u a'n CD117, day IS da'u an khdng bpc

16 d te bSo co ngudn gde cd trdn hay than kinh, mS

bde 16 d te bao ke Cajal d thSnh dng tieu hoa (day la

te bao nam xen giifa he than kinh tU dpng thSnh rupt

vS te bao cd trdn thSnh rupt, cd chife nang dieu hda

nhu dpng rupt). Vi vay hau bet cac nhS y hpe tren the

gidi da xep eae u trung m6 dng tieu hda cd bpc Ip

GD117 thanh mpt nhdm u rieng va ngudn gde eua

ehung la tif te bSo ke Cajal d thanh dng tieu hda [1],

[2], [9]. Ke tir nam 1998, hai nha khoa hpe mpt ci!ia

Nhat la Hirota va mpt cua Thuy Dien IS Kindblom phSt

hien nhom u nay khi phSn ti'ch gen cua khdi u nSy vS

thS'y da sd eo dot bien gen c-kit (80-85%) [5], [6], [10],

tif do u nSy ehfnh thifc dUde gpi ten la u m6 dem da

dSy-rupt hay u md dem dng tieu hda (GIST:

Gastrointestinal Stromal Tumors/TSD: Tumeur

Stromale Digestive) [3], [9].

Tren the gidi cung da cd eSc nghien cifu ve loai u

58 Y HOC THVC HANH (729) - SO 8/2010